Hyoid Bone Fracture Research Articles

Fracture of the Hyoid Bone Associated With Atlantoaxial Subluxation

Hyoid bone fractures secondary to blunt trauma other than strangulation are rare. Only 27 cases have been reported in the literature. They have few, if any, complications, such as dysphagia, hypoxia, cardiorespiratory collapse, laceration of the pharynx, mandibular fracture, thyroid cartilage fracture, and facial fracture. No report of hyoid bone fracture associated with spinal column injury was reported in the English literature. The authors reported a 46-year-old male patient who complained of neck pain and odynophagia after a traffic accident. After systemic examination and cervical CT scan, the diagnosis of hyoid bone fracture at the right great horn and atlantoaxial subluxation was made. The patient was observed in ICU for 48 hours. A nasogastric tube was inserted for feeding. Fifteen milligrams of dexamethasone was given once a day for 3 days to reduce the swelling and pain. We performed a cutaneous traction for the subluxation and carefully watched the hyoid bone and the patient's respiration. No lethal complications occurred. Two weeks later, the patient was allowed to ambulate with cervical collar protection and to resume oral intake. Three months later, he was asymptomatic. This case, with hyoid fracture and atlantoaxial subluxation, is the only case reported in the literature. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missing diagnosis. Nonsurgical management may be effective in most of the cases.

Incomplete decapitation in suicidal hanging – Report of a case and review of the literature

Complete or incomplete decapitation is an unusual complication of suicidal hanging. We present a case of incomplete decapitation due to hanging with soft tissue injuries, spinal cord dissection between C2 and C3, fracture of the hyoid bone and injuries of cartilages. The 52-year-old male victim with a 95 kg body mass used a 1.5 cm thick and 3.1 m long nylon rope snap-hooked to a rafter. The comprehensive literature review of incomplete or complete decapitation by suicidal hanging emphasises the importance of investigation of biomechanical process. In the presented case we calculated the physical parameters (final speed: 7.8 m/s, kinetic energy: 2945 J, force: 9500 N). The previous observations were confirmed that body weight and falling distance were the most important factors in the pathomechanism of decapitation. In the hanging process energy can be stored by changing the position of the human body in the gravitational field, by changing the shape of the hanging rope and by changing the motion of the hanging body. We concluded that the occurrence of complete or incomplete decapitation can increase by the increasing energy stored as potential energy at the starting position and the characteristics of the rope extended by the hanging body.

Forensic aspects of complications resulting from cardiopulmonary resuscitation

While cardiopulmonary resuscitation (CPR) can save lives, it can also injure patients. As a result, forensic pathologists often see CPR-related injuries during autopsies that are unrelated to the patients’ primary cause of death. Therefore, pathologists must be able to distinguish between CPR-related injuries and those caused by other factors, such as assaults or accidental violence. This distinction is complicated because even therapeutically unimportant injuries can have forensic significance. For example, resuscitative injuries are observed frequently in the neck and the chest. This article focuses mainly on complications due to ventilation and chest compression during CPR. The following iatrogenic complications are described: bruising and abrasions in the face and neck, fractures of the hyoid bone and thyroid cartilage, air way injuries, vomitus aspiration, positional error of the tube for intra-tracheal intubation, petechiae, retinal hemorrhages, subarachnoid hemorrhages, rib and sternum fractures, bone marrow embolism, cardiac injuries including myocardial hemorrhages and frothy heart blood, and injuries to the abdominal organs such as liver and spleen.

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

Neck Structure Injuries in Hanging – Comparing Retrospective and Prospective Studies

Deaths due to hanging are common among suicides. Various studies in the forensic literature have reported considerable differences in the frequency of hyoid bone or thyroid cartilage fractures and injuries to the musculature and the vasculature of the neck. Some important reasons to which these variations could be attributed include: lack of a common method for examination of neck structures, varying degrees of thoroughness in examining the neck structures and lack of seriousness in the documentation of the findings (as cases of hanging are almost always suicidal) thus affecting the results of retrospective studies. The present study was conducted retrospectively (1994 to 1999) and prospectively (2000 to 2003) on 108 cases of hanging. Seventy-one per cent of the cases were male and 29% female, aged between 15 to 60 years. Hanging was typical in 20% of cases and atypical in 80%; it was complete hanging in 46% of cases and incomplete in 54% of cases. Neck structure fractures were found to be more common in atypical complete hangings; the incidence was found to be 10% in the retrospective group and 27% in the prospective group. Contusions and lacerations of musculature were found in 20% of cases in the retrospective group and 34% in the prospective group, thus stressing the need for thorough postmortem examinations and meticulous documentation of the findings.

Have you checked your hyoid lately? Strangulation, pathology, trauma, accident

Fractures of the human hyoid bone encountered in forensic anthropology cases involving apparent homicide victims have been interpreted as markers of strangulation. Caution is required in this assessment since modifications of the hyoid bone, cervical vertebrae, and cartilage of the trachea, thyroid and larynx may be the results of arrested ontogenetic development, hard-force trauma, autopsy mishandling and pathology. Some ten agents involving compression of circulatory vessels conducting blood to and from the brain are reviewed in this study which concludes with an account of a case investigated by the author where a homicide victim, a young Afro-American female living in Syracuse, New York, had a damaged hyoid bone. However, she had not been strangled by her aggressor; he killed her by pushing her living body against a wall. Only by examining all of the preserved osseous and cartilaginous structures of the neck may the forensic anthropologist achieve an accurate reconstruction of the manner of death associated with hyoid bone fractures.

舌骨骨折，披裂軟骨脱臼を併発した下顎骨骨折の１例

We report a case of mandibular fracture combined with hyoid bone fracture and arytenoid dislocation caused by injury. The patient was a 28-year-old man who was assaulted by several persons at a shopping quarter at midnight. He was unable to breathe or speak for a while, but these symptoms disappeared while he was rubbing his neck. He was transported by ambulance to our hospital. There was no dyspnea, and he could speak. He complained of swallowing pain and trismus. A fracture line was found in the left side of the coronoid process of the mandible on radiography. CT imaging showed a fracture in the right great horn of the hyoid bone, with inflammatory edema around the hyoid bone and epiglottis. Moreover, the arytenoid cartilage had been bilaterally dislocated posteriorly. Closed reduction and fixation was performed to treat the mandibular fracture, and the laryngeal injury was observed. Laryngeal injuries, even in the absence of symptoms or functional disorders immediately after injury, can later cause airway obstruction. Careful diagnosis is therefore necessary.

An isolated hyoid fracture secondary to sport injury: A case report and review of literature

A 16-year-old boy sustained a fracture of the hyoid bone following closed neck injury from a hockey puck. Though commonly occurring in association of other fractures of the laryngeal skeleton, the fracture was isolated and a comprehensive evaluation implicated it solely for the clinical picture. Our review of the English literature displays the diversity of opinion on classification and treatment. It also indicates, however, that hyoid fractures are usually managed successfully with minimum intervention as indeed our case was.

Isolated hyoid bone fracture: Review of an unusual entity

Fractures of hyoid bone resulting from trauma other than strangulation are very rare, isolated hyoid bone fractures are even rarer, and occur more frequently in young individuals, and in men more than in women. A comprehensive review of the world literature, also two rare cases of isolated hyoid bone fractures induced by direct trauma onto the anterior neck are presented. Additionally, a table summarizing 31 cases from 1954 to 2003, is included. Mechanism of injury, diagnosis, complications, prognosis, and treatment are discussed.

Pathologic features of fatal falls from height.

Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.

Sexual asphyxia by hanging – a case report and a review of the literature

A case of sexual asphyxial death by hanging is presented. A 35-year-old male, found dead lying on his face in a bed of a truck cab, had hanged himself from a window frame using a leather belt. He was completely naked. There were pornographic and sadomasochistic magazines beneath his face, opened to pages depicted nude photographs of a woman. Autopsy findings revealed a ligature mark on the neck and petechial hemorrhages in the conjunctivae, but there were no hemorrhages in the neck muscles or fractures of the hyoid bone or the thyroid cartilage. The alcohol levels in the blood and urine were 0.78 and 0.45 mg/ml, respectively. The circumstances suggested that his death was accidental, and due to asphyxia by hanging performed to enhance sexual gratification during masturbation. Sexual asphyxia is reviewed and discussed.

Die isolierte Zungenbeinfraktur

We present a rare case of isolated hyoid bone fracture caused by direct trauma. We will describe the mechanism of injury, how to find diagnosis and our treatment.

Fractures of the hyoid bone and laryngeal cartilages in suicidal hanging

A prospective study of neck trauma associated with suicidal hanging was undertaken at the Forensic Science Centre, Adelaide over a 3-year period from July 1996 to June 1999. There were a total of 40 cases of suicidal hanging with an age range of 17-74 years (average = 35 years; M:F = 33:7). Fractures of neck structures were identified in 19 cases (47.5%) and were more common in older victims and males. Nine victims had only thyroid cartilage fractures (22.5%), four victims had only fractures of the hyoid bone (10%), and six victims had fractures of both the hyoid bone and thyroid cartilage (15%). No fractures of the cricoid cartilage or cervical spine were demonstrated. Potentially confusing issues encountered in the assessment of possible fractures of neck structures included cases where there was congenital absence of the greater horn of the thyroid cartilage, where accessory nodules of cartilage were present in the posterior margin of the thyrohyoid membrane, and where there had not yet been bony fusion of the cartilaginous joints between the greater horns and body of the hyoid bone.

Dysphagia secondary to iatrogenic hyoid bone fracture

Dysphagia as a result of an iatrogenic fracture of the hyoid bone is presented. Review of the world literature reveals this phenomena to be previously unreported following surgery.

Traumatic Fracture of the Hyoid Bone: Three Case Presentations of Cardiorespiratory Compromise Secondary to Missed Diagnosis

Hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounting for only 0.002 per cent of all fractures. The world literature reports only 21 cases. Surgical intervention involves airway management, treatment of associated pharyngeal perforations, and management of painful symptomatology. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missed diagnosis. We submit three cases with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients required emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was managed conservatively. After fracture, the occult compressive forces of hematoma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning, leading to cardiorespiratory collapse. With endotracheal intubation prohibited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion based on mechanism of injury is mandated.

Age and Sex-Related Variation in Hyoid Bone Morphology

Although the relationship between hyoid bone shape and fracture pattern figures prominently in forensic investigations of strangulation, few quantitative data exist on age and sex differences in hyoid morphology. An image analysis system was used to take a series of 30 measurements on digitized radiographs of 315 hyoid bones from people of known age and sex. The degree of fusion of the greater cornua to the hyoid body was also recorded. Statistical analysis of these data shows that there is a continuous distribution of hyoid bone shapes and the most bones are highly symmetrical. Based on smaller samples, previous researchers have suggested that non-fusion is more common in women than in men. In contrast, our data suggest that men and women have similar non-fusion rates. Analysis of sexual dimorphism shows that the greatest length differences are in the greater cornua. There are also significant sex differences in hyoid shape. For example, the distal ends of the greater cornua of women are significantly longer than those of men.

CT Evaluation of Laryngotracheal Trauma.

Laryngotracheal injuries are rare, and typically associated with multisystem trauma. They may be blunt or penetrating in nature, and are in the great majority of cases related to motor vehicle accidents or ÒclotheslineÓ injuries with a small percentage due to direct blows sustained during assaults or athletic contests, hanging or manual strangulation, or other less common etiologies including iatrogenic causes. Missed diagnoses or mismanagement may result in the patient's death or significant long-term morbidity. The radiologist must be familiar with the normal computed tomographic (CT) appearance of laryngotracheal anatomy to correctly interpret CT studies following injury, and must also be aware of the central role that CT plays in diagnosis, management, and selection of therapy. This should include an understanding of the Shaefer classification of laryngeal injuries that is based on a combination of the CT and endoscopic findings. Although an acceptable evaluation of the traumatized larynx is obtainable with most commercially available CT scanners, optimal studies are produced by CT devices capable of spiral technique and subsecond scan times, particularly in regard to their ability to generate thin retrospectively reconstructed two-dimensional (2D) axial sections, 2D coronal and sagittal images, and three-dimensional (3D) images. Our discussion of laryngotracheal injuries is divided into four parts. Part 1 deals with injuries to the endolaryngeal soft tissues structures, including the mucosa, vocal cords, and deep compartments. The ability of CT to demonstrate endolaryngeal edema and hematoma, vocal cord injuries, subcutaneous emphysema, and aspirated radiopaque foreign bodies is discussed along with its inability to demonstrate the site of mucosal perforations or degloving injuries. Part II deals with fractures of the hyoid bone, epiglottis, and thyroid and cricoid cartilages, while Part III discusses dislocations of the cricoarytenoid and cricothyroid joints. Finally, Part IV discusses laryngotracheal separation, the most immediately life-threatening laryngotracheal injury, and the difficulties inherent in making this diagnosis prospectively by CT.

Frequency of throat-skeleton fractures in hanging.

A total of 109 cases of suicidal or accidental hanging were evaluated and the number of hyoid bone or thyroid cartilage fractures or both was investigated in relation to the highest point of the ligature mark. In 73 cases (67%), at least a single fracture of the throat skeleton was detectable, and the youngest individual with positive findings was aged 14 years. In 28 of the 73 positive cases (38%), a single fracture was found, whereas 27 individuals (37%) showed a twofold injury. Three fractures of the throat skeleton were observed in 11 cases (15%), and in seven individuals (10%), all the horns of the hyoid and thyroid cartilage were broken. The youngest individual with four fractures was 28 years old (elastic non-ossified throat skeleton). Even though a higher incidence of positive results and in particular of multiple fractures could be established in cases with a highest point of the ligature mark at or behind the ears, no clear correlation between frequency and number of throat-skeleton fractures was detectable in our series.

Fracture of the Hyoid Bone in Strangulation: Comparison of Fractured and Unfractured Hyoids from Victims of Strangulation

The hyoid is the U-shaped bone of the neck that is fractured in one-third of all homicides by strangulation. On this basis, postmortem detection of hyoid fracture is relevant to the diagnosis of strangulation. However, since many cases lack a hyoid fracture, the absence of this finding does not exclude strangulation as a cause of death. The reasons why some hyoids fracture and others do not may relate to the nature and magnitude of force applied to the neck, age of the victim, nature of the instrument (ligature or hands) used to strangle, and intrinsic anatomic features of the hyoid bone. We compared the case profiles and xeroradiographic appearance of the hyoids of 20 victims of homicidal strangulation with and without hyoid fracture (n = 10, each). The fractured hyoids occurred in older victims of strangulation (39 +/- 14 years) when compared to the victims with unfractured hyoids (30 +/- 10 years). The age-dependency of hyoid fracture correlated with the degree of ossification or fusion of the hyoid synchondroses. The hyoid was fused in older victims of strangulation (41 +/- 12 years) whereas the unfused hyoids were found in the younger victims (28 +/- 10 years). In addition, the hyoid bone was ossified or fused in 70% of all fractured hyoids, but, only 30% of the unfractured hyoids were fused. The shape of the hyoid bone was also found to differentiate fractured and unfractured hyoids. Fractured hyoids were longer in the anterior-posterior plane and were more steeply sloping when compared with unfractured hyoids. These data indicate that hyoids of strangulation victims, with and without fracture, are distinguished by various indices of shape and rigidity. On this basis, it may be possible to explain why some victims of strangulation do not have fractured hyoid bones.

Hyoid Bone Fracture: Report of Two Cases

Hyoid Bone Fracture: Report of Two Cases